Title: The Trump Administration and America's Worst Measles Outbreak in Decades

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Brian: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. Now, our health and climate Tuesday section of the show, which we do every week on this day, and yes, it is Tuesday, not Monday today, right? Today, we're on the health side of things. Measles was declared eliminated from the United States back in 2000, but today the country is experiencing its largest measles outbreak in 30 years, and it started, as many of you know, in West Texas. As cases mounted, local health officials pleaded for help from the CDC, the Centers for Disease Control.

For weeks, though, according to a new report in KFF News, no one at the agency picked up the phone. By the time federal scientists finally responded, children had died and the outbreak had spread into several states and across the border into Mexico. Amy Maxmen at KFF Health News obtained hundreds of emails showing how politics inside the Trump administration prevented CDC scientists from doing their jobs. They were muzzled, sidelined, even instructed to insert misinformation about the so-called benefits of vitamin A into their official communications.

Local doctors and parents were left to deal with the crisis on their own. Amy Maxmen joins us now with what her reporting revealed about how public health broke down when science was politicized. Amy Maxmen, PhD, national public health correspondent at KFF Health News, joins us to share her stellar reporting on all this. Amy, welcome back to WNYC. Always glad to have you on the show.

Amy: Hi, Brian. It's a pleasure to be back.

Brian: Can we just start with the consequences of this outbreak? Your article says the Texas outbreak spread to New Mexico, Oklahoma, Kansas, Colorado, and Mexico's Chihuahua State. At minimum, together, these linked outbreaks have sickened more than 4,500 people, killed at least 16, and levied exorbitant costs on hospitals, health departments, and those paying medical bills. I guess, Amy, that number 16 killed, at least 16, you say, was new to me. We've heard a lot about the 2 child deaths in Texas, which by themselves were probably unnecessary. 16 people?

Amy: Yes. Llike you said, there's two children that died in Texas who were unvaccinated, so preventable, and there was an adult in New Mexico, which is just across the area that was across the border from Texas, where an adult died with measles. The other deaths are all in Mexico, which is actually now facing a massive outbreak, one of its kind of record-breaking outbreaks in a long time, because there was a child that's part of the Mennonite community in Mexico who went and visited family in Texas and then returned home when they were infected, and that has sparked a massive outbreak in the Chihuahua state. Most of those deaths are there, and that's ongoing.

Brian: Are you blaming that on RFK Jr or the anti-vax movement in the United States? Are you saying we exported that to Mexico, or is that oversimplifying?

Amy: I would say it's a little bit oversimplifying, because it's so hard to know a counterfactual, but the cases definitively are linked. We know that based on epidemiology, which is knowing who went where when they were infected, we know that the outbreak in Texas spread to Mexico. We know it spread to New Mexico. Definitely the outbreak in Texas, as it got big, spread, and the bigger it gets, like a wildfire, it can be put out quickly when it's small, or it gets bigger and bigger and bigger, and it's harder to control, and it goes more places and has more effects. Even though the outbreak in West Texas is now over, some of the outbreaks that it sparked elsewhere continue to burn.

We can talk about how has RFK contributed to this, and how has just the turmoil at the CDC contributed. That's why I was curious about this first month of the outbreak in Texas. Like I said, you want to snuff it out when it's small. The outbreak was basically the beginning of when the first cases in Texas were detected coincides when Donald Trump took office. Then if you remember that first month, the Trump administration froze federal communications. There was a month of turmoil, basically, where there was dozens of staff at CDC were laid off. I've written about CDC reports were being halted. CDC data was being taken down from websites. There was a lot of turmoil.

It wasn't that RFK said that the CDC wasn't allowed to respond so specifically. I talked with people within the CDC who said they were hampered from just reaching out to health officials who were asking for help in West Texas in that first month, because of all of this chaos and fear, and they didn't have a green light to be able to speak. At the same time, in all of these emails I saw, I saw West Texas health officials saying, "We really want to consult with the CDC."

Brian: This is going to be new to a lot of listeners that the CDC, the Centers for Disease Control at the federal government level, was prohibited from communicating with health officials at the state level. You report a child in Texas died before the CDC ever spoke directly with Katherine Wells, the public health director in Lubbock, who was trying to get in touch, or the state, through her, was trying to get in touch with the feds. Why did it take a full month for scientists there to get clearance to respond?

Amy: Like I was saying, it was all of this chaos was happening. When I spoke with CDC scientists, and I should say I did not name them in the article, I agreed not to because they fear retaliation, they didn't speak directly. In normal times, they have to be invited in by the state, but typically, I had multiple people tell me that in typical times, they could easily call up the local health officials on the front lines. They have measles experts at the CDC, and they are there to answer complicated questions like Katherine Wells had, which come up in a really bad outbreak.

They were on they were afraid to just contact and talk to her directly. They didn't have a green light from their higher-ups. At this time, they were busy basically being censored, and so they were afraid to just go ahead and just do it, even though they were not given a green light to do it. That was happening. At the same time, after Kennedy took office, he then was going on national news, and he was saying things like, parents can get their kids vaccinated. HHS will provide vaccines. Parents can get their kids vaccinated if they choose that. Then he would follow it up with just misinformation about measles vaccines.

He was saying things like measles vaccines cause all of the harms of measles, like encephalitis, and they definitively do not cause encephalitis. He was saying measles vaccines have fetus debris in it. They don't have fetus debris in it. He would say these things that would understandably make parents afraid of getting vaccinated. At the same time, he was saying nutrition and vitamin A wards off all of the worst effects of measles. One can understand why parents might think, "I won't get my child vaccinated, but maybe I'll just buy some vitamin A from the pharmacy." That was actually happening.

In the emails that I obtained from these local health departments, Texas doctors and health officials were saying that they were having kids come in in a late stage with measles who had really high levels of vitamin A, and that can be toxic. There's some signs that vitamin A is helpful in areas where there's huge vitamin A deficiency, like in studies in sub-Saharan Africa, but we really don't see vitamin A deficiency very often in the US. This was the fear.

Brian: This was another part of the article that was new to me, so it'll be new to a lot of listeners, probably, that doctors in Lubbock were treating kids for toxic levels of vitamin A because parents thought it was safer than the vaccine. What did you learn about how widespread that was?

Amy: No, I can't give you numbers. Reporting's really bad. I could cite different other news articles that have come out about that. I saw in the emails that's something that health officials were worried about. There was an article saying that the big drug stores in West Texas, they were stocking out of vitamin A. RFK actually went on Fox News and said they're shipping vitamin A and cod liver oil, which has high levels of vitamin A, to Texas.

I spoke with one CDC scientist, and they told me this was really scary because vitamin A is not water-soluble, which means it can accumulate in the body, and at high levels, it can cause some pretty nasty effects. It can cause liver damage. If pregnant women take high levels of vitamin A, it can cause really dire fetal abnormalities. They were really afraid about this.

Now, the CDC, what the scientists told me is they were told to insert vitamin A into their communications. They managed to get it in there by saying things like you should only use vitamin A under a doctor's supervision. They put that in, but what I heard from the people I spoke with was that they were worried that-- You can just buy vitamin A so that people wouldn't speak to their doctors first.

Brian: Listeners, do we have any Texans in our audience right now or people in any of those other areas? New Mexico, Mexico, Oklahoma, Kansas, Colorado, anywhere who also been affected by the measles outbreak this year, 212-433-WNYC with a question for Amy Maxmen, the national public health correspondent at KFF Health News, 212-433-WNYC, 212-433-9692. Her article called "As Measles Exploded, Officials in Texas Looked to CDC scientists. Under Trump, No One answered." Of course, anyone else can ask a question as well or send a comment, text, or call 212-433-WNYC, 212-433-9692.

A couple of people are following up on the Mexico aspect of this that you mentioned earlier, that the outbreak spread from Texas into Mexico. One listener writes, and this is just a commentary from the listener, "Imagine the outrage in this country if a measles outbreak originating in Mexico had spread across the border to the US." Then another listener asked this question: "What are Mexico's measles vaccine policies?" Do you know if they generally have universal vaccine requirements to enter elementary school, that kind of thing, like we do in most places in this country?

Amy: It's a fabulous question, and I don't know what their school policies are. I know they have measles vaccine programs, but clearly, there's a lot of under-vaccination. It's always about pockets of under-vaccination. You could have pretty good measles vaccine rates overall, but if you go into a community where there's low vaccine rates, which is what happened in West Texas, then it really explodes. There's estimates that if you have 10 people who are unvaccinated in a room and one of them has measles, 9 of those people are going to get measles.

It's extremely infectious for people who aren't vaccinated. I don't know what the policies are in schools there. I think the problems in Mexico, and I'm not an expert on this, but I think some of the problems are lower vaccine rates in particular communities, and also if there's not great access to healthcare, then you have people being treated late, which is never good.

Brian: Before we go to some more listener questions and comments, you mentioned earlier that the outbreak has ended in West Texas. Is that in any way confirmation of RFK Jr's theory that outbreaks will run their course, they won't become huge epidemics when we're talking about measles? Whatever risks there are of vaccines, he can argue that this is not the end of the world, this is not COVID-2020, and maybe he didn't like those vaccines either, but as a comparison, this is not COVID-2020 when a measles outbreak takes place to warrant universal vaccination.

Amy: I don't want to give him credit because all virologists know that, typically, when you're infected by something, you do accumulate some immunity to it. A lot of people would say that the reason why measles ended eventually-- I should say once the CDC kicked in and once they arrived in mid-March, they were effective, and things got underway, I just wondered why not sooner. I talked to a lot of people who felt like the reason why it ended ultimately is that everybody in the area of Gaines County in Texas that could have been infected was infected, and it did burn itself out that way. People did gain natural immunity through having measles.

Here's the thing. Number one, losing a child is awful. I don't know, I haven't experienced it, and I can't imagine what it's like. It's extremely sad. Losing anybody is extremely sad, and it doesn't need to happen. It's costly in terms of a child's life who didn't need to die. It's costly in terms of how much money-- I think New York put upwards of $7 million into the measles outbreak that we had here in 2019. It's extremely expensive for health departments to try and chase after a measles outbreak.

It's extremely expensive for hospitals. The emails I saw hospitals were saying, "We are at capacity." Not only is there the medical cost, which can be around $20,000 or so for a hospitalization from measles. Not only is there medical cost, but they have to clear out the hospital rooms where somebody with measles is. They have to contact everybody who was in contact or might have been exposed within the hospital with measles. There's a lot of legwork, which is people work, that goes into trying to control this thing.

Kids might have to stay home from school, which means they're missing out on school. Parents might have to stay home from work to care for their kids. These are very costly outbreaks, and it's very preventable with an extremely effective and extremely safe vaccine. You could just let it run rampant and say, "It's all right. We're just going to spend millions that didn't need to be spent and allow children to suffer and die, and then eventually it'll go away," or we could use a simple vaccine, which we have. Thanks to science. It seems like the latter of those two choices is the one that makes sense.

Brian: Now we have a Health and Human Services Secretary who rejects that science and argues that the measles vaccine, the MMR vaccine, is doing more damage to kids than measles outbreaks.

Amy: Which isn't true.

Brian: There's so much evidence. We have debates on this show. That's what we do. There's just so much overwhelming evidence. We've gone through it with previous guests. There's so much overwhelming evidence that you don't even know what to say about having authorities who just ignore it and recommend counterfactual policies that appear to have become really dangerous.

You saw probably that Senator Bernie Sanders had an op-ed the other day calling for Kennedy to be fired. I guess we could say, on the one hand, Democrats always call for Republican appointees to be fired and vice versa. I don't know. Maybe people will pick this up as a special case. You report on health, not politics so much, but this is a political story too with the CDC.

Amy: Oh, yes.

Brian: Look who did get fired. It's Susan Monare, the deputy director of the Centers for Disease Control.

Amy: Absolutely. The American Public Health Association has called on RFK to resign. They had early on. The American Academy of Pediatrics has put out worrying statements. Half a dozen former directors of the CDC, they had an op-ed in The New York Times over the past few days that is also highly concerned. These are directors who worked under Republican and Democratic presidents. You're right, there's always some degree of back and forth between the different parties, but I think what I'm seeing now is unlike what I've ever seen before.

Brian: Listener texts, "As a pediatric emergency physician, I saw vitamin ingestions pretty frequently. Children's vitamins are candy-like and appealing. They are, for the most part, benign. The only one we worried about was vitamin A, which can cause acute brain swelling in addition to the problems mentioned." Writes that pediatric emergency physician about RFK Jr sending out vitamin A shipments as an alternative to measles vaccines. Anne, in Manhattan, originally from Oklahoma, one of the places where the measles outbreak spread to. Anne, you're on WNYC. Hello.

Anne: Hello.

Brian: What you got, Anne?

Anne: I just returned from Oklahoma last week from a family visit. Vaccinations are plummeting. Now, the case that makes Oklahoma unique is that it's the only state, according to physicians, that doesn't even report the number of measles cases. If you look at the map and you look at the reports, it says there are no reported cases of measles.

However, the physicians there will tell you that there are indeed cases, especially on the Texas border. At the same time, there are a record number of whooping cough cases, and you even have tuberculosis resurging in Oklahoma and Texas and Kansas as well. My family lives a few blocks from an elementary school. The parents who are looking to vaccinate their children, the number is dropping rapidly, so it's a disaster.

Brian: Anne, thank you very much. Do you know anything about the lack of reporting the measles cases that the caller is alleging? Amy, we know this is one of the things in general where there is pressure from the new administration is not to report all the scientific data that there is, but here's an alleged lack of reporting of actual cases.

Amy: Measles is still a reportable disease. If a person tests positive for measles, they have to report it to the state and the state to the CDC. Oklahoma's Department of Health reports 20 total cases so far in their outbreak. Now, what happened in Texas, and what happens often, is people might not get tested. I think in Texas, what I heard is a lot of parents chose to just listen. My child has a rash, probably has measles symptoms, or a lot of schools would see it, and if these are private schools or home schools, they would just decide to keep the kid home or something and not report it. In that case, yes, there's underreporting because the case isn't being detected.

I haven't yet heard that when there's a confirmed case through testing that that's not being reported. Certainly, I think there might be an unknown as far as people not being tested. The other thing that's often unknown is vaccination. A lot of states, New York does, but a lot of states don't have statewide vaccination records. You'll often see unknown listed, and that's because people won't say if they're vaccinated, which often means they're not. Also, the state doesn't record it, but a lot of states do, like New York. That's another problem when collecting data.

Brian: Listener writes, "I've heard that the outbreak has spread to something like 43 states." I did hear New York a week or two ago. I don't know if it wound up spreading, but there was a warning about somebody having ridden on public transportation. I don't have it in front of me. I think it was on a subway line. Maybe it was on a Metro-North rail line, Metro-North of Long Island Railroad. They wanted everybody to know who might have ridden whatever that line was at that particular time, that somebody who then later got confirmed to have measles was on the train. That's New York, pretty far from West Texas. Do you know to this listener's text that it showed up in something like 43 states?

Amy: I love this question because I really tried to chase this down from my story. You will see that. I've seen it in various places, the idea that the measles outbreak that it's spread to 43 states. I think even New York Times website, at some point, had mentioned something like that. The short answer is, I don't know. We know that we have a record-breaking year by far for measles this year, which is definitely because of vaccination rates, which have been going down since 2020.

As far as did the West Texas outbreak spread to all of these places? I really don't know. I was very conservative in naming the four states that I know it spread to. As far as the other ones, I wrote a lot of other states, and I don't know anyone that knows. I know that those four are linked because there's epidemiology links. What scientists do is they'll sequence the strain of the measles that's going around in each of these places, and then they can tell is the genetic material from that measles virus exactly the same, because that would suggest this is the same one that's spreading everywhere.

I haven't seen that, they call it genotypic data. I haven't seen that data out there, which is very odd to me. I've written in states about it, then I wrote the CDC about it. They did respond to this question, and they don't have a confirmation that it's actually linked to those 43 states. It's a big question mark, but we do know the four states or so that I listed in my piece.

Brian: Listener, our program note on tomorrow's show, we're going to talk about their new restrictions on COVID vaccines. We'll try to give you some news you can use, as we call it, for those of you who may want to get a COVID vaccine. Of course, that's up to you this fall, and may have a hard time doing so, because of the new rules coming from HHS and RFK. That'll be on tomorrow's show.

Let me end with you, Amy, today with this. I don't know if you want to go all the way there, but here's a text from a listener that says, "Aside from the fascist playbook of controlling information, and breaking institutions and trust in government, what is their endgame?" On the premise that it's at least a fascist playbook, according to this listener, of controlling information and breaking institutions, I don't know if you saw a New York Times story the other day about the historic link between authoritarian governments and trying to break trust in science.

For example, one line was, "The dictators of the 20th century turned the suppression of basic science and the promotion of applied research into super weapons of social control. Upon taking power in 1933, Hitler redefined German science to include the idea that Aryans represent the master race." You get where that was going. If we accept that at least RFK Jr actually believes in these theories, which science does not confirm, from a Trump standpoint, might he be using it, whether he believes in it or not, the RFK stuff, to help assert control over everything by declaring control over information that refutes accepted science?

Amy: I really can't or don't want to speak to-- I don't know what's in Trump's head. If there's a playbook, I don't know what it is. What I can say is that it's a very real fear that you would have decisions from our science agencies, which are there to provide the best policy decisions based on evidence. That's why we need them to be our-- There can be all these different groups that put out advice, but we want a national group to base decisions on evidence and not on the political endpoint that they want to see or based on these kind of conspiratorial ideas.

We want decisions to be based on evidence. Right now, there is a real fear that's grounded in just the past several months, which is why we saw these high-level resignations in the past week. We have top CDC experts resigning, people who are really civil servants to the highest degree, who are resigning because of the fear that they're going to have to rubber-stamp decisions that aren't based on evidence, but based on politicization, political ends, and that's truly disturbing.

To say big picture beyond Texas, my piece is the other concern, which is not only are we talking about recommendations, but some of our agencies, like the CDC, our emergency response agencies, we need them to be there and to be able to have the scientists that have been employed there because they have the training. We need those scientists to be able to be our outbreak responders, to be our emergency responders. That could be a cluster of cancer cases or lead poisoning or a salmonella outbreak or another pandemic, which we could get. There's no reason to think that COVID's it. We don't want to just have these agencies be put on ice or caught up in turmoil. I think that would be what I can say.

Brian: Amy Maxmen's article in KFF Health News is called, "As Measles Exploded, Officials in Texas Looked to CDC Scientists. Under Trump, No One Answered." Thank you so much for sharing it with us.

Amy: Thank you so much.

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